How can I increase my HDL (High-Density Lipoprotein) levels?

How to Increase HDL Cholesterol Levels

Regular aerobic exercise is the single most effective lifestyle intervention for raising HDL cholesterol, requiring at least 30 minutes of moderate-intensity activity 5 times weekly, with a dose-response relationship showing greater benefits at higher exercise volumes. 1, 2

Exercise: The Primary Intervention

Exercise should be your first-line approach for raising HDL cholesterol. The evidence consistently demonstrates that physical activity produces meaningful HDL increases through a clear dose-response relationship 1, 2:

For Healthy Individuals

• Perform at least 30 minutes of moderate-intensity aerobic exercise 5 days per week (minimum threshold) 1, 2, 3
• Optimal regimen: prolonged moderate-intensity aerobic exercise at 70-80% heart rate reserve 1, 2
• Add low-intensity resistance training at 50% of 1 repetition maximum (1RM) 1, 2
• Target total energy expenditure of 1,200-2,200 kcal/week (equivalent to 7-14 miles of brisk walking weekly) 1, 4

For Those with Dyslipidemia

• Progress to higher intensity: 85% maximum heart rate 1, 2
• Increase resistance training to moderate-to-high intensity at 75-85% 1RM 1, 2
• The combination of aerobic and resistance training provides superior lipid profile improvements compared to either alone 1, 2, 3

Critical Exercise Principles

• A threshold must be exceeded before HDL increases occur - sporadic or minimal activity will not produce results 4
• HDL increases of 0.08-0.15 mmol/L (3-6 mg/dL) are achievable with consistent training 1
• The dose-response is linear: more exercise yields greater HDL elevation 1
• Aerobic exercise volume (via increased intensity and/or duration) has greater impact than resistance training intensity alone 1

Weight Management

Achieve and maintain a healthy body weight if overweight or obese. 1, 2, 3

• Weight reduction improves HDL by approximately 0.01 mmol/L (0.4 mg/dL) for every kilogram lost once weight stabilizes 1
• Weight loss is particularly critical for individuals with both low HDL and elevated triglycerides 1
• Combining diet with weight loss and physical activity can increase HDL by 10-13% 5

Dietary Modifications

Replace saturated fats with unsaturated fats rather than carbohydrates to optimize HDL levels. 1, 2, 3

Fats to Emphasize

• Increase monounsaturated fats (olive oil, canola oil, avocados) - these maintain or slightly increase HDL 1, 2, 3
• Include polyunsaturated fats (nuts, seeds, fatty fish) in moderation 2, 3
• Saturated fats increase both LDL and HDL, but the net cardiovascular effect is unfavorable 1

Fats to Avoid

• Eliminate trans-unsaturated fatty acids completely - these lower HDL while raising LDL 1, 2
• Limit saturated fat to <7% of total calories 3, 5

Carbohydrate Considerations

• Avoid high-carbohydrate diets, especially refined carbohydrates and sugars - these reduce HDL by 0.1 mmol/L (4 mg/dL) for every 10% energy substitution from fat 1, 2, 3
• When consuming carbohydrates, choose low glycemic index foods with high fiber content to minimize HDL reduction 1
• High fructose/sucrose intake causes more pronounced HDL decreases 1

Fiber and Other Nutrients

• Increase soluble fiber intake (10-25g/day) from legumes, fruits, vegetables, and whole grains 1, 3
• Include plant stanols/sterols (2g/day) 3

Smoking Cessation

Quit smoking immediately - cessation can increase HDL cholesterol by up to 30%. 1, 2, 3

This represents one of the most powerful single interventions for HDL improvement 1.

Alcohol Consumption

If you drink alcohol, limit to moderate consumption only. 1, 3

• Moderate intake (10-20g/day for women, 20-30g/day for men) is associated with increased HDL compared to abstainers 1
• However, excessive alcohol aggravates hypertriglyceridemia and carries other health risks 1, 3
• This should not be interpreted as a recommendation to start drinking if you currently abstain 1

Pharmacological Options (When Lifestyle Is Insufficient)

If lifestyle modifications fail to achieve adequate HDL levels after 3-6 months, consider pharmacotherapy 1, 3:

First-Line Medications

• Niacin (nicotinic acid) is the most effective drug for raising HDL cholesterol 1, 2

  • Caution: Can adversely affect blood glucose control in diabetics 1, 2

• Fibrates (fenofibrate, gemfibrozil) effectively increase HDL and reduce triglycerides 1, 2, 6

  • Fenofibrate is indicated as adjunctive therapy to increase HDL in primary hypercholesterolemia or mixed dyslipidemia 6
  • Dose adjustment required in renal impairment 6

Statins

• Some statins (particularly pitavastatin and rosuvastatin) produce modest, sustained HDL increases 7
• However, statins are primarily LDL-lowering agents with inconsistent HDL effects 7

Common Pitfalls to Avoid

• Very low-fat diets (<15% of calories from fat) paradoxically lower HDL - avoid this approach 3
• Replacing saturated fat with refined carbohydrates worsens the lipid profile - use unsaturated fats instead 1, 3
• Sporadic exercise below the threshold volume will not raise HDL - consistency and adequate volume are essential 4
• Relying on medication alone without lifestyle modification limits long-term success 3

Monitoring

• Measure lipid levels annually in adults with risk factors 1, 3
• If values are at low-risk levels, reassess every 2 years 1
• Evaluate lifestyle interventions at regular intervals, with consideration of pharmacotherapy at 3-6 months if targets are not met 1, 3

Important Context

While low HDL is associated with increased cardiovascular risk, it has not been conclusively demonstrated that raising HDL through diet and lifestyle modifications directly reduces coronary disease events. 1 However, the interventions that raise HDL (exercise, weight loss, smoking cessation) independently reduce cardiovascular risk through multiple mechanisms beyond HDL elevation alone 1.